Surgery should be performed once full range of motion is obtained; Arthroscopic ACL reconstruction is usually undertaken in young, active patients because the ACL will not heal unless surgically restored. With each episode of instability, more cartilage damage may occur; ligaments can be repaired quite well, but native cartilage cannot be replaced. A brace will also not guarantee prevention of further knee "pivot" injuries. The ACL must be reconstructed with a biological graft that can heal fully by regaining full blood supply. Graft options include: A) Autograft tissue from a patellar tendon graft or a hamstring graft; B) Allograft tissue from the patellar tendon, hamstring, or achilles tendon.
Surgery may not be recommended for older, less active patients who do not participate in cutting and twisting sports. An ACL is typically not needed for easy hiking, walking, swimming, or cycling. In this case, bracing of the knee may be selected as optimal treatment, as long as instability is not present. This patient group should also avoid aggressive sports in the future.
Once surgery is performed, your surgeon may have you non-weightbearing for a time and in a brace. CPM’s or continuous passive motion devices may sometimes be used. The first week after surgery typically involves ice and elevation. Try to limit how much time you get up when possible.
Physical therapy is generally started about a week after surgery and initially focuses on range of motion. Later phases concentrate on strength and proprioception. Agility drills may be used in preparation for return to sport. This may take from four to six months depending on your doctors protocol. Your doctor may suggest the use of a sports brace for a period of time as you transition to full activity.
ACL surgery is very successful at stabilizing the knee. Meniscal damage or chondral injuries (injury to the surface cartilage that lines the bones), may have some long term consequences on what activity you should or shouldn’t pursue. You and your doctor can make that decision together.